The CDC’s opioid guidelines are being revised, and the proposed 2022 CDC guidelines have been issued. If these guidelines are adopted as proposed, we would have missed an opportunity-to incorporate Interventional Pain Management-yet again. The CDC guidelines is seeking stakeholder comments before April 11, 2022. Your voice and the voice of your patients are critical because the proposed guidelines are suggesting that there is minimal evidence for IPM, and that IPM is not effective, undermining the true role of IPM in both diagnosing and treating the patient holistically.
Ask the CDC for the following in your own words. To submit your comments, identify Docket No. CDC-2022-0024. Federal Rulemaking Portal: http://www.regulations.gov.
The CDC must advocate for multidisciplinary care, personalized for each individual patient. This includes behavioral therapy, restorative therapy, complementary medicine pharmacologic therapies, and Interventional Pain Management (IPM) strategies. This is consistent with the AMA and the 2019 HHS Best Practices report that embrace a multidisciplinary model that includes IPM.
IPM procedures, including epidural and facet joint interventions, spinal cord stimulation, infusion systems, minimally invasive endoscopic surgery, interspinous prosthesis, and other nerve block, in conjunction with opioids, are both safe and effective. The proposed 2022 CDC guidelines are suggesting that IPM procedures have limited evidence and are unsafe. the language that suggests that IPM has limited evidence and is not safe should be removed.
Please contact Congress requesting that they ask the CDC to adopt the 2019 HHS Best Practices report, specifically Section 2.4 dealing with IPM.
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ASIPP 24th Annual Meeting
May 5-7, 2022 | Las Vegas, Nevada
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24 YEARS & COUNTING!
Focusing on Fundamentals to Build the Future of IPM
Discussion on health policy with three prominent members of congress:
- The Honorable Ed Whitfield
- The Honorable Larry Buschon
- The Honorable James Comer
Raj/Racz Distinguished Lectures:
- Neuromodulation
- Documentation of medical necessity to perform epidural and facet joint intervention LCDs and evaluation and management services
Multiple General Session Topics:
- Various types of solutions in epidural injections
Keynote speech by Harsha Shanthanna, MD
- Facet joint interventions
- The opioid/illicit drug epidemic
- Compassionate prescribing
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April 3 is the last day to get the best rates in the ASIPP block! |
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Government seeks to recoup more than 2 years of payments for unproven treatments
Medicare is clawing back money it paid doctors for dubious birth tissue injections -- a move that likely could put some clinics out of business, an orthopedic surgeon told MedPage Today.
In late February, seven U.S. regional Medicare Administrative Contractors (MACs) announced that they will seek to recover losses from claims going back more than 2 years, for shots that cost some $2,000 apiece. For clinics that injected patients in multiple joints with at least two doses per joint, that could total thousands of dollars per day.
"Any claims processed and paid for dates of service on or after Dec. 6, 2019 will be adjusted and payment will be recouped," stated the announcement from WPS Government Health Administrators, which covers the Midwest region. "Impacted providers will receive an overpayment demand letter identifying the amount of overpayment."
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NEXT EXAM DATES:
Part I
Saturday, April 2 & Saturday, May 28
Part II
Friday, July 15 & Friday, September 23
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Republicans, Democrats differ on potential costs and effects of Medicare for All
Democratic and Republican House members appeared as far apart as ever Tuesday on the issue of the best way to achieve universal healthcare coverage in the U.S.
"Republicans are serious on this committee about trying to solve the healthcare problems we have in America, but bigger government and government-run healthcare is not the solution to the problem," said Rep. James Comer (R-Ky.), ranking member of the House Oversight and Reform Committee, which held a hearing on "Examining Pathways to Universal Health Coverage."
For a large number of Democratic committee members, however, government-run healthcare -- such as through a "Medicare for All" program -- was exactly the answer. "For my colleagues on this committee, you have a choice in front of you today," said Rep. Cori Bush (D-Mo.). "It's a choice to save lives or a choice to let people die ... I came to Congress because 'Medicare for All,' it's not a choice for me. It's a moral imperative."
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The Supreme Court is considering this question in Ruan v. United States
Earlier this month, the Supreme Court heard oral arguments in a case that will impact how doctors can treat patients where opioids are involved. The threshold question in Ruan v. United States, which came to the Supreme Court from the U.S. Court of Appeals for the Eleventh Circuit, is when the care a doctor provides patients crosses the line into a criminal act where the doctor is prescribing opioids.
Xiulu Ruan, MD, practiced medicine as a board‐certified pain specialist in Alabama, and was indicted in 2016 for unlawful distribution of opioids. The jury in the trial court convicted Ruan and other physicians in his practice based on a ruling that did not allow doctors to claim a defense of "good‐faith" where they honestly prescribed opioids under the belief that it was the right thing to do medically. Once the case reached the Eleventh Circuit on appeal, Ruan was essentially doomed, as that federal appellate circuit does not recognize a good-faith defense in cases such as this. He lost and appealed to the Supreme Court on a writ of certiorari, a court process to seek judicial review of a decision from a lower court.
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- ASIPP Members Only Site Information - |
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To log in for the first time you will need to click “forgot password” at the bottom of the login window.
- Check your email and then log in as directed.
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If you have problems logging into your account, click here.
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Pain Medicine Case Reports (PMCR) and Editor-in-Chief Alaa Abd-Elsayed, MD, PhD would like to invite you to submit case reports and case series to the PMCR journal. Your article will be published free of charge.
Open access journals are freely available online for immediate worldwide open access to the full text of published articles. There is no subscription fee for open access journals. Open access journals are no different from traditional subscription-based journals: they undergo the same peer-review and quality control as any other scholarly journal.
Interested in becoming a member of the PMCR Editorial Board?
Editorial board members are asked to review 2-6 manuscripts per year. Please submit your most up-to-date CV to sgold@asipp.org for consideration.
For more information or to submit your articles, click here.
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| CASE REPORT |
Ryan Barrera, MD, and Krishna B. Shah, MD
Abstract
BACKGROUND: Kümmell’s disease is a rare diagnosis that involves avascular necrosis of the vertebral body after minor injury. Presentation is subtle and there are pathognomonic findings on imaging. Treatment ranges from symptom management to vertebral augmentation to open surgery depending on patient preference.
CASE REPORT: We evaluated the case of an 88-year-old woman with a past medical history of scoliosis who presented to clinic complaining severe low back pain with associated neurologic symptoms 2 weeks after a fall at home. Imaging showed avascular necrosis of T12.
CONCLUSIONS: After discussion with the patient, she elected to proceed with a unilateral lumbar medial branch block over vertebral augmentation. Pain scores greatly improved and opioid usage decreased.
KEY WORDS: Case report, Kümmell’s disease, avascular necrosis, medial branch block
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New edition now available! |
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| HEALTH SERVICES RESEARCH |
Laxmaiah Manchikanti, MD, Vanila Mathur Singh, MD, Peter S. Staats, MD, Andrea M. Trescot, MD, John Prunskis, MD, Nebojsa Nick Knezevic, MD, PhD, Amol Soin, MD, Alan D. Kaye, MD, PhD, Sairam Atluri, MD, Mark V. Boswell, MD, PhD, Alaa Abd-Elsayed, MD, and Joshua A. Hirsch, MD
Abstract
BACKGROUND: In the midst of the COVID-19 pandemic, data has shown that age-adjusted overdose death rates involving synthetic opioids, psychostimulants, cocaine, and heroin have been increasing, including prescription opioid deaths, which were declining, but, recently, reversing the trends. Contrary to widely held perceptions, the problem of misuse, abuse, and diversion of prescription opioids has been the least of all the factors in recent years. Consequently, it is important to properly distinguish between the role of illicit and prescription opioids in the current opioid crisis. Multiple efforts have been based on consensus on administrative policies for certain harm reduction strategies for individuals actively using illicit drugs and reducing opioid prescriptions leading to curbing of medically needed opioids, which have been ineffective. While there is no denial that prescription opioids can be misused, abused, and diverted, the policies have oversimplified the issue by curbing prescription opioids and the pendulum has swung too far in the direction of severely limiting prescription opioids, without acknowledgement that opioids have legitimate uses for persons suffering from chronic pain.
Similar to the opioid crisis, interventional pain management procedures have been affected by various policies being applied to reduce overuse, abuse, and finally utilization. Medical policies have been becoming more restrictive with reduction of access to certain procedures, with the pendulum swinging too far in the direction of limiting interventional techniques. Recent utilization assessments have shown a consistent decline for most interventional techniques, with a 18.7% decrease from 2019 to 2020.
The causes for these dynamic changes are multifactorial likely including the misapplication of the 2016 Centers for Disease Control and Prevention (CDC) guidelines for prescribing opioids for chronic pain, the relative ease of access to illicit synthetic opioids and more recently issues related to the COVID-19 pandemic. In addition, recent publications have shown association of dose tapering with overdose or mental health crisis among patients prescribed long-term opioids. These findings are leading to the hypothesis that federal guidelines may inadvertently be contributing to an increase in overall opioid deaths and diminished access to interventional techniques. Together, these have resulted in a fourth wave of the opioid epidemic.
METHODS: A narrative review.
RESULTS: The fourth wave results from a confluence of multiple factors, including misapplication of CDC guidelines, the increased availability of illicit drugs, the COVID-19 pandemic, and policies reducing access to interventional procedures. The CDC guidelines and subsequent regulatory atmosphere have led to aggressive tapering up to and including, at times, the overall reduction or stoppage of opioid prescriptions. Forced tapering has been linked to an increase of 69% for overdoses and 130% for mental health crisis. The data thus suggests that the diminution in access to opioid prescriptions may be occurring simultaneously with an increase in illicit narcotic use.
Combined with CDC guidelines, the curbing of opioid prescriptions to medically needed individuals, among non-opioid treatments, interventional techniques have been affected with declining utilization rates and medical policies reducing access to such modalities.
CONCLUSION: The opioid overdose waves over the past three decades have resulted from different etiologies. Wave one was associated with prescription opioid overdose deaths and wave two with the rise in heroin and overdose deaths from 1999 to 2013. Wave three was associated with a rise in synthetic opioid overdose deaths.
Sadly, wave four continues to escalate with increasing number of deaths as a confluence of factors including the CDC guidelines, the COVID pandemic, increased availability of illicit synthetic opioids and the reduction of access to interventional techniques, which leads patients to seek remedies on their own.
KEY WORDS: Opioid overdose deaths, rapid tapering, access to interventional techniques, Agency for Healthcare Research and Quality, Centers for Disease Control and Prevention, Centers for Medicare and Medicaid Services, Drug Enforcement Agency, Food and Drug Administration, conflicts of interest
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| SURVEY |
Rebecca Dale, DO, Logan Kinch, MD, Lynn Kohan, MD, Timothy Furnish, MD, Rene Przkora, MD, PhD, Shalini Shah, MD, Boris Spektor, MD, Shravani Durbhakula, MD, Manuel Lombardero, MS, and Scott Brancolini, MD
Abstract
BACKGROUND: The COVID-19 pandemic ushered in a shift to a video format for pain medicine fellowship interviews for the 2021-2022 academic year, which represented a major change in the fellowship interview paradigm.
OBJECTIVES: Our aim was to assess the experience of a video-only format in place of in-person interviews for Pain Medicine fellowship program directors and applicants after the 2020 fellowship interview season to determine the feasibility for continuation beyond COVID-19 travel restrictions.
STUDY DESIGN: Survey via Qualtrics.
SETTING: Academic pain medicine programs.
METHODS: A consortium of program directors converged to discuss methods for determining the effectiveness and future direction of the video format for pain medicine fellowship interviews. Two surveys were formulated, one targeting pain medicine fellowship program directors and the other for candidates interviewing for the year 2021-2022.
RESULTS: For applicants, 55 out of 170 responded for a response rate of 32.3%, and for program directors, 38 out of 95 responded for a response rate of 40%. Of the applicants, 45.7% stated that they would prefer video interviews, whereas 27.3% of program directors preferred video interviews. Savings of time and money were the most common reason for preferring video interviews.
LIMITATIONS: The number of pain fellowship applicants invited was limited to those who interviewed at a subset of pain fellowships, which may not have been representative of all pain fellow applicants.
CONCLUSIONS: The video format for pain medicine fellowship interviews was viewed positively by both candidates and program directors. We suspect that the video format alone or as a part of a hybrid model will become a routine method for the interview process in the future, given its time and cost benefits.
KEY WORDS: Video format interview, tele-interview, virtual interview, pain medicine fellowship
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Since this malpractice insurance program officially launched in November 2018, ASIPP has signed up hundreds of providers with an average savings of 30%. This is professional liability insurance tailored to our specialty and will stand up for us and defend our practices.
Norcal Mutual is A-Rated by AM best and is licensed in all 50 states. To read a few important points to keep in mind about the program, including discounts, administrative defense, cyber coverage, aggressive claims handling, and complimentary award-winning risk management CME activities, click here.
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ASIPP® has formed a partnership with Henry Schein and PedsPal, a national GPO that has a successful history of negotiating better prices on medical supplies and creating value-added services for independent physicians. Working with MedAssets, PedsPal provides excellent pricing on products like contrast media that alleviate some of the financial pressures you experience today.
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ASIPP® is now offering our members the benefit of a unique revenue cycle management/ billing service.
We have received a tremendous amount of interest in the ASIPP® billing and coding program.
Click here to learn more about the negotiated rate for practices and more!
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up-to-date news related to you, your practice, and your patients!
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